EKG Rhythm Strips 16: Atrial Rhythms
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Atrial Fibrillation with Rapid Ventricular Response. The rhythm is irregular with a rate of 150 beats/min. There are no P waves or PR intervals. Atrial fibrillation is often identified based upon the ventricular rate. If the rate is over 100 beats/min, it is called afib with a rapid ventricular response. If the rate is between 60-100, it is called afib with a controlled ventricular response. And if the rate is less than 60, it is called afib with a slow ventricular response.
Atrial Fibrillation with Slow Ventricular Response. The rhythm is irregular. There are no readily identifable P waves. It almost looks like there are multiple small flutter waves present. Because this rhythm has some characteristics of both afib and aflutter, some might identify this rhythm as a fib/flutter rhythm.
Wandering Atrial Pacemaker. The rhythm is irregular. There are multiple PACs of varying morphology in this rhythm strip. There are at least 3 different P waves of varying morphology. The PR interval will also change with each different P wave. When the rate is < 100 this rhythm is called wandering atrial pacemaker. When the rate exceeds 100 it is called multifocal atrial tachycardia.
Atrial Fibrillation. The rhythm is irregular. There are not any readily identifable P waves.
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Answers.
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| Atrial Fibrillation with Rapid Ventricular Response |
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| Atrial Flutter with Variable Rate |
Atrial Flutter with Variable Rate. In general, atrial flutter is often has a regular rate and rhythm. Though sometimes, as above, it is irregular with a variable amount of flutter waves (f waves) between the QRS complexes. The risk of developing an atrial thrombus is the same as atrial fibrillation.
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| Supraventricular Tachycardia |
Supraventricular Tachycardia. The rhythm is regular with a rate at 166 beats/minute. Because the rate is so fast the P waves, if present, may be buried within the ST segment of the preceding complex thus making it difficult to ascertain the origin of the rhythm. In general narrow complex rhythm with a rate over 150 is often identified as a supraventricular rhythm. It could either be atrial flutter, atrial fibrillation, or a junctional tachycardia. Name five vagal maneuvers that can be performed on the patient to slow down rate.
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| Atrial Flutter |
Atrial Flutter. The rhythm is regular. There are more than one P waves for each QRS complex. There are 3 flutter waves for each QRS complex. Notice that the T wave with each complex appears taller than usual. This is because a flutter wave has merged or is buried within in the T wave. Often you will hear people say that atrial flutter has a "saw tooth" appearance.
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| Multifocal Atrial Tachycardia |
Multifocal Atrial Tachycardia. The rhythm is irregular. There are multiple PACs of varying morphology in this rhythm strip. For this rhythm is be identified as multifocal atrial tachycardia there must be at least 3 different P waves and the rate must be over 100 beats/min. There is also an isolated PVC
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| Atrial Tachycardia |
Atrial Tachycardia. The rhythm is regular. There is one P wave for each QRS complex. The rate is 187 beats/minute. Unlike SVT, the P waves are readily identifiable.
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| Atrial Flutter |
Atrial Flutter. The rhythm is regular. There are more than one P waves for each QRS complex. There are 3 flutter waves for each QRS complex. What is the rate?
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| Atrial Fibrillation with Slow Ventricular Response |
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| Wandering Atrial Pacemaker |
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| Atrial Fibrillation |
Reviewed 2/28/16
Hi, thank you for posting these images. I am actually interested in using one of them, (#1) for a textbook on ECGs in clinical medicine. Please let me know if and how I can obtain permission to do so. Thanks! Nick Hartman, MD
ReplyDeleteI post the images for educational purposes. They are free to anyone who has need of them. So, you have permission to use the images or any others. Thanks for asking.
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